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The Effects of Nitric Oxide for Inhalation in Right Ventricular Infarction Patients

8. september 2016 opdateret af: Mallinckrodt

The Effects of Nitric Oxide for Inhalation on Survival or the Need for Dialysis or a Right Ventricular Assistance Device (RVAD) in Right Ventricular Infarction Patients

This study is designed to better understand the effects of nitric oxide, a gas for inhalation, on patients with right ventricular infarction.

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

This is a prospective, randomized, double-blind, placebo-controlled study that will assess the feasibility of studying inhaled nitric oxide for the treatment of cardiogenic shock due to right ventricular infarction, and the dose response of the acute hemodynamic changes occurring with nitric oxide inhalation in these patients. Patients with evidence of right ventricular infarction and cardiogenic shock, and have angiographic evidence of impaired blood flow to the right ventricle, or if right ventricular coronary perfusion is unimpared, cardiac shock persists, will be eligible for enrollment. Patients will receive standard of care for their condition, and will also recieve either nitric oxide for inhalation or placebo for up to 14 days.

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

3

Fase

  • Fase 2

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

  • Belgien
      • Leuven, Belgien, B-3000
        • University Hospital Gasthuisberg, University of Leuven
  • Canada
    • Ontario
      • Ottawa, Ontario, Canada, K1Y 4W7
        • Univeristy of Ottawa Heart Institute
  • Forenede Stater
    • Massachusetts
      • Boston, Massachusetts, Forenede Stater, 02114
        • Massachusetts General Hospital
    • Michigan
      • Royal Oak, Michigan, Forenede Stater, 48073
        • William Beaumont Hospital
  • Polen
      • Alpejska, Polen, 42
        • Institute of Cardiology Warsaw
  • Spanien
      • Barcelona, Spanien, 08036
        • Cardiovascular Department, Hospital Clinic

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år og ældre (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  • Acute inferior mycardial infarction (defined as an episode of chest pain lasting >30 minutes and electrocardiographic evidence of 1 mm or greater ST elevation in inferior leads) within the past 72 hours.
  • Invasive hemodynamic evidence of hemodynamically-significant RV dysfunction, defined as the presence of all the following: systemic venous congestion (mean RA pressure > 10mmHg), the ratio of RA/PCW pressure 0.75 or greater, a low cardiac output as determined by Fick or Thermodilution (TD) technique (cardiac index < 2.5 l/min/m2), systolic systemic arterial blood pressure of 90mmHg or less or requiring vasopressor or mechanical support to maintain systolic pressure > 90mmHg. Patients with a PCWP of 14mmHg or less should receive intravascular volume repletion until their PCWP is > 14mmHg.
  • Coronary angiography revealing either an occlusion of the RCA proximal to any RV marginal branch or evidence of diminished flow to RV marginal branches of the RCA.
  • If patient undergoes coronary revascularization, there must be evidence of unsuccessful right ventricular reperfusion (lack of restoration of TIMI grade III flow in the distal RCA and > 1mm RV marginal branches) or evidence of hemodynamically significant RVI must persist for greater than 1 hour after successful revascularization.
  • Age 18 years or greater

Exclusion Criteria:

  • PCW 25mmHg or greater or mechanical complications of myocardial infarction requiring surgical correction.
  • Severe LV systolic dysfunction as determined by the principal investigator. Unprotected left main coronary stenosis > 50%.
  • Pulmonary infiltrates consistent with pulonary edema on chest X-ray (if chest X-ray is clinically indicated).
  • Evidence of shock-related end-organ damage, including creatinine 3.0 or greater, metabolic acidosis (pH 7.1 or less) and not corrected by 100 ml NaHCO3 (1mEq/ml), disseminated intravascular coagulation, or clinical evidence of diffuse brain injury.
  • Previous history of severe pericardial, congenital, or valvular heart disease.
  • Refractory hemodynamically significant arrhythmia.
  • Presence of pneumonia, adult respiratory distress syndrome, or sepsis.
  • Prior history of pulmonary disease requiring chronic oxygen therapy.
  • Pregnancy
  • Use of investigational drugs or device within the 30 days prior to enrollment to the study.
  • Uncontrolled active bleeding.

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Tredobbelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Aktiv komparator: 1
inhaled nitric oxide at 40 or 80ppm
Medicin: inhaled nitric oxide
Continuous delivery at either 40 or 80 ppm for a duration of up to 14 days
Andre navne:
  • INOmax
Placebo komparator: 2
inhaled nitrogen at either 40 or 80ppm
Medicin: nitrogen gas
Continuous delivery at either 40 or 80 ppm for a duration of up to 14 days

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Tidsramme
survival to hospital discharge or Day 30, whichever occurs first without the need for renal replacement therapy or a Right Ventricular Assistance Device (RVAD)
Tidsramme: hospital discharge or Day 30
hospital discharge or Day 30

Sekundære resultatmål

Resultatmål
Tidsramme
survival at 1 year after initial hospitalization
Tidsramme: 1 year post treatment
1 year post treatment
time on vasoconstrictor or inotropic medications
Tidsramme: study duration
study duration
duration of intraaortic balloon pump support, if applicable
Tidsramme: study duration
study duration
time in intensive care unit
Tidsramme: study duration
study duration
duration or need for mechanical ventilation
Tidsramme: study duration
study duration
change in cardiac index by dose
Tidsramme: baseline, hour 8, days 3 & 7, and at day 30 or discharge
baseline, hour 8, days 3 & 7, and at day 30 or discharge
change in right ventricule function and size by dose
Tidsramme: baseline, hour 8, days 3 & 7 and at day 30 or discharge
baseline, hour 8, days 3 & 7 and at day 30 or discharge
change in pulmonary vascular resistance by dose
Tidsramme: study duration
study duration
change in any right-to-left intracardiac shunt flow, as assessed by contrast echocardiography
Tidsramme: study duration
study duration
neurohormonal assessment of prognosis with BNP, NT-pro BNP
Tidsramme: Baseline, hour 8 and days 3 & 7
Baseline, hour 8 and days 3 & 7
incidence of mortality
Tidsramme: treatment duration through 1 year
treatment duration through 1 year
incidence and types of reported adverse events
Tidsramme: study duration through day 30 or discharge
study duration through day 30 or discharge

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Mallinckrodt

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart

1. marts 2006

Primær færdiggørelse (Faktiske)

1. februar 2007

Studieafslutning (Faktiske)

1. februar 2007

Datoer for studieregistrering

Først indsendt

29. oktober 2008

Først indsendt, der opfyldte QC-kriterier

29. oktober 2008

Først opslået (Skøn)

31. oktober 2008

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Skøn)

9. september 2016

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

8. september 2016

Sidst verificeret

1. september 2016

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • INOT43

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